Provider First Line Business Practice Location Address:
614 E ARCH ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-824-8288
Provider Business Practice Location Address Fax Number:
270-824-8288
Provider Enumeration Date:
02/06/2012